# SOUTH ALABAMA PEDIATRIC DENTISTRY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437289303
- **Authorized official:** DR. EARL GAINES THOMAS D.M.D (OWNER)
- **Authorized official phone:** (251) 345-1717

## Contact information

- **Practice address:** 801 UNIVERSITY BLVD S, STE B, MOBILE, AL 36609-2923
- **Practice address phone:** (251) 345-1717
- **Practice address fax:** (251) 343-0835
- **Mailing address:** 801 UNIVERSITY BLVD S, STE B, MOBILE, AL 36609-2923
- **Mailing address phone:** (251) 345-1717
- **Mailing address fax:** (251) 343-0835

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 3282 | AL | Yes |

## Other

- **Enumeration date:** 03/07/2007
- **Last updated:** 12/31/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 529912670 | — | AL |